Fall 2009

Up in the Air

Health Care And The Free Market

Marc Solomon

Last year, I had the privilege and opportunity to learn how to fly. Flying in general has taken quite a beating this year – especially when speaking of corporate officers and corporate jets. Somehow that expense seems frivolous. Will flying ever be as economical as driving or walking? Probably not. Sure, we will see refinements in airplane fuels and economy, but that is just good business. Perhaps a solar powered plane. But the essence of flight is not about whether it is the most utilitarian way to go from one point to another. It is about soaring above the dirt and seeing the land from afar. That need is of the human spirit seeking more than a cold cave to live in. It seems both frivolous and magnificent at the same time. But its ultimate conclusion, 40 years ago, resulted in the metaphysically challenging feat of Neil Armstrong stepping onto the surface of the moon. Was that frivolous? Was it necessary?

Why do we fly? To get there faster, to leap over the mountains and rivers, to get from point A to point B in the shortest time possible.

To save time.

Why is time so important? If other people – other than you – were all that mattered, your life would be meaningless. But as you read this, it is your life we are talking about. You are not a species; you are not a tribe. Your life matters. So, is it okay for you to fly? Whose choice is it, then? Does someone else know better than you how to spend the precious moments you have left on this planet, in this physical form that feels joy and pain, boredom and excitement, love and hate? Can anyone else tell you that? Can you pick any group of five people that you don't know, and trust them with that decision? How about any hundred, or one thousand people, or any gang off the street?   How about being given the choice to pick from two people you don't know who will pick a bunch more people you don't know to make the decision?  Yes, dear Reader, the end of this fugue is government. But I have a feeling you enjoy being in charge of your life.

Last time we chatted, I suggested we give up name-calling; I'm going to stick to that. But I think it is important for us to continue the discussion of collectivism versus individualism. This goes to the very heart of the health care debate. I think doctors are people too. Medicine is a hard won skill. We know all about the years of study and college costs, the brutal sleepless residencies these people have to pass through in order to call themselves doctors. So then, how do we imagine we can conjure doctors at will?  So we can we agree that the supply of medical expertise is limited, and cannot be printed like worthless paper dollars?

If medical care is eternally limited in supply, then how does a society get access?  Through free trade of skill and supplies for compensation. But not everyone needs the same amount of care nor would choose the same level of care. Other than the occasional cold or flu, serious injuries or life-threatening illness are not a certainty for anyone.  Therefore, each person has different ideas about what care is necessary and different ideas about how much money should be spent on healthcare.  Thus free choice, and the free market, is important.

People created insurance to limit costs when there is uncertainty. Insurance is a gamble. It's a gamble between the person offering the insurance at a price, and the hope on the part of the insured that the policy is not needed. For those of us who pay insurance on our cars or houses, we certainly aren't paying anywhere near the full value of replacement if the former were stolen or the latter burned down.  Neither do we want either to happen.  If every home eventually burns, there would be no fire insurance.  An insurer is betting these things don't happen either. Their business is to figure out how to make a profit, while realizing at the same time that some of those terrible things are going to happen to some of us, but not all of us.  They take the risk.

An insurance company is not evil in serving its mission as a business to make a profit.  If it commits fraud by not paying off on a policy, then it should be prosecuted, both civilly and criminally, and by dint of publicity, it will be punished in the free market by a reduction in new policies and renewals.  It then mends its ways and provides better service in order to win back the goodwill of the market.  Else it dies. 

Is our public debate about insurance or access? The problem supposedly being solved is about some number of people who don’t have coverage.  There are arguments about how many, or whether some even choose to have it.  We can agree that there some who do not, and want it.  Does everyone need the same?  

Since everyone eats food, why isn’t there a protest for food insurance?  Sound stupid? I hope so. Let’s face it, the unspoken political promise of universal medical insurance is really about free health care.  Caring people can help feed their neighbors.  Medical skills are not so plentiful.

Yes, neither guarantee is provided or implied by the Constitution. 

The problem is government.  The answer is not government.  How did this nation get to a point where the price of medical care is got to be high, when all other services and products fell in price for most?  Did capitalism fail?  No.  Government did.  I grew up without insurance, and was not without care.  Lots of people were the same.  What’s the difference?  Not so long ago, before the feds stuck their noses in, along with many misguided states, many levels of affordable insurance could be had.  For those more bold, more young, more healthy, catastrophic coverage policies were dirt cheap.  For those illnesses that now put some into bankruptcy, as we are let to believe, anyone could be covered for a pittance.  But government, coupled with special interests began to vilify the insurance industry to make political points and demand minimum coverage across a gamut of optional conditions (like I’m getting pregnant.) So much so that now, some areas have only one insurer, as the government has driven the rest off. Free Market forces are not allowed to work in heath care today.  Ask any doctor. Mandatory paperwork, government regulations and malpractice insurance drives their costs of providing the care they wanted to dedicate their lives to.  Chasing payment from the remaining government-approved insurers, for fees dictated by Medicare policy, drives the rest.

Politicians can’t print doctors, hospitals, nurses or emergency rooms.  Someone must want to make a profit for his or her time or risk. Say you become a doctor. After all those years of study, would you be willing to allow every moment of your time to be used like a slave? For pay that you think is unfair? Most of the doctors I know work pretty hard. They see patients back-to-back in 10-minute intervals.  Where are the thousands of more doctors going to come from?  Give uncontrolled demand a chance, and all of us will suffer.  Make it a law to accept government insurance and rates? The doctors will disappear.  It’s already happening.  Many physicians are not accepting any insurance.  Are they soaking anyone? Or are they the best offering the best at a fair price?

If we are truly becoming a nation of the chronically sick, then medical insurance of any kind will no longer be viable.  No one will be in that business anymore.  Since the gamble no longer would exist, then health care, as a business, will turn into a garden-variety retail transaction … like it used to be.
No insurance company can hurt anyone then.  Revise tort law to remove the crushing burden of malpractice and its horrific burden on physicians. Then there is no one to blame.  Let doctors and hospitals, and pharma too, without government interference, compete in the open market to provide the best products and services at the lowest cost. Hold all to standard liability, fraud and warrantee laws.  It has worked in every other corner of the American economy, once the world’s beacon of hope.  The alternative is the DMV.
It is impossible to give--or steal for--everyone what they want all the time. It is only possible for those of us who are willing to work, study, save, or plan to hope to be able to offer something of value in exchange for what we need. But our need for something does not cause it to be. It is the best part of a rational society--a free trade society--that there are some of us who want to do certain things and some of us who want to do other things. Some of those people want to become doctors, and God bless them. Some of us want to save hours and days of our lives by getting from point A to point B in a few hours, rather than sitting in a covered wagon for a month.